Combining situated Cognitive Engineering with a novel testing method in a case study comparing two infusion pump interfaces.

We validated the usability of a new infusion pump interface designed with a situated Cognitive Engineering approach by comparing it to a reference interface using a novel testing method employing repeated measurements and process measures, in addition to traditional outcome measures. The sample consisted of 25 nurses who performed eight critical tasks three times. Performance measures consisted of number and type of errors, deviations from a pre-established normative path solution, task completion times, number of keystrokes, mental effort and preferences in use. Results showed that interaction with the new interface resulted in 18% fewer errors, 90% fewer normative path deviations, 42% lower task completion times, 40% fewer keystrokes, 39% lower mental effort and 76% more subjective preferences in use. These outcomes suggest that within the scope of this case study, combining the situated Cognitive Engineering approach with a novel testing method addresses various shortcomings of earlier testing methods.

Task analysis of information technology-mediated medication management in outpatient care.

AIMS: Educating physicians in the procedural as well as cognitive skills of information technology (IT)-mediated medication management could be one of the missing links for the improvement of patient safety. We aimed to compose a framework of tasks that need to be addressed to optimize medication management in outpatient care. METHODS: Formal task analysis: decomposition of a complex task into a set of subtasks. First, we obtained a general description of the medication management process from exploratory interviews. Secondly, we interviewed experts in-depth to further define tasks and subtasks. SETTING: Outpatient care in different fields of medicine in six teaching and academic medical centres in the Netherlands and the United States. PARTICIPANTS: 20 experts. Tasks were divided up into procedural, cognitive and macrocognitive tasks and categorized into the three components of dynamic decision making. RESULTS: The medication management process consists of three components: (i) reviewing the medication situation; (ii) composing a treatment plan; and (iii) accomplishing and communicating a treatment and surveillance plan. Subtasks include multiple cognitive tasks such as composing a list of current medications and evaluating the reliability of sources, and procedural tasks such as documenting current medication. The identified macrocognitive tasks were: planning, integration of IT in workflow, managing uncertainties and responsibilities, and problem detection. CONCLUSIONS: All identified procedural, cognitive and macrocognitive skills should be included when designing education for IT-mediated medication management. The resulting framework supports the design of educational interventions to improve IT-mediated medication management in outpatient care.

Training situational awareness to reduce surgical errors in the operating room.

BACKGROUND: Surgical errors result from faulty decision-making, misperceptions and the application of suboptimal problem-solving strategies, just as often as they result from technical failure. To date, surgical training curricula have focused mainly on the acquisition of technical skills. The aim of this review was to assess the validity of methods for improving situational awareness in the surgical theatre. METHODS: A search was conducted in PubMed, Embase, the Cochrane Library and PsycINFO using predefined inclusion criteria, up to June 2014. All study types were considered eligible. The primary endpoint was validity for improving situational awareness in the surgical theatre at individual or team level. RESULTS: Nine articles were considered eligible. These evaluated surgical team crisis training in simulated environments for minimally invasive surgery (4) and open surgery (3), and training courses focused at training non-technical skills (2). Two studies showed that simulation-based surgical team crisis training has construct validity for assessing situational awareness in surgical trainees in minimally invasive surgery. None of the studies showed effectiveness of surgical crisis training on situational awareness in open surgery, whereas one showed face validity of a 2-day non-technical skills training course. CONCLUSION: To improve safety in the operating theatre, more attention to situational awareness is needed in surgical training. Few structured curricula have been developed and validation research remains limited. Strategies to improve situational awareness can be adopted from other industries.

The role of cognitive abilities in laparoscopic simulator training.

Learning minimally invasive surgery (MIS) differs substantially from learning open surgery and trainees differ in their ability to learn MIS. Previous studies mainly focused on the role of visuo-spatial ability (VSA) on the learning curve for MIS. In the current study, the relationship between spatial memory, perceptual speed, and general reasoning ability, in addition to VSA, and performance on a MIS simulator is examined. Fifty-three laparoscopic novices were tested for cognitive aptitude. Laparoscopic performance was assessed with the LapSim simulator (Surgical Science Ltd., Gothenburg, Sweden). Participants trained multiple sessions on the simulator until proficiency was reached. Participants showed significant improvement on the time to complete the task and efficiency of movement. Performance was related to different cognitive abilities, depending on the performance measure and type of cognitive ability. No relationship between cognitive aptitude and duration of training or steepness of the learning curve was found. Cognitive aptitude mediates certain aspects of performance during training on a laparoscopic simulator. Based on the current study, we conclude that cognitive aptitude tests cannot be used for resident selection but are potentially useful for developing individualized training programs. More research will be performed to examine how cognitive aptitude testing can be used to design training programs.

Systematic review of serious games for medical education and surgical skills training.

BACKGROUND: The application of digital games for training medical professionals is on the rise. So-called 'serious' games form training tools that provide a challenging simulated environment, ideal for future surgical training. Ultimately, serious games are directed at reducing medical error and subsequent healthcare costs. The aim was to review current serious games for training medical professionals and to evaluate the validity testing of such games. METHODS: PubMed, Embase, the Cochrane Database of Systematic Reviews, PsychInfo and CINAHL were searched using predefined inclusion criteria for available studies up to April 2012. The primary endpoint was validation according to current criteria. RESULTS: A total of 25 articles were identified, describing a total of 30 serious games. The games were divided into two categories: those developed for specific educational purposes (17) and commercial games also useful for developing skills relevant to medical personnel (13). Pooling of data was not performed owing to the heterogeneity of study designs and serious games. Six serious games were identified that had a process of validation. Of these six, three games were developed for team training in critical care and triage, and three were commercially available games applied to train laparoscopic psychomotor skills. None of the serious games had completed a full validation process for the purpose of use. CONCLUSION: Blended and interactive learning by means of serious games may be applied to train both technical and non-technical skills relevant to the surgical field. Games developed or used for this purpose need validation before integration into surgical teaching curricula.

Effects of two types of intra-team feedback on developing a shared mental model in Command & Control teams.

In two studies, the effect of two types of intra-team feedback on developing a shared mental model in Command & Control teams was investigated. A distinction is made between performance monitoring and team self-correction. Performance monitoring is the ability of team members to monitor each other's task execution and give feedback during task execution. Team self-correction is the process in which team members engage in evaluating their performance and in determining their strategies after task execution. In two experiments the opportunity to engage in performance monitoring, respectively team self-correction, was varied systematically. Both performance monitoring as well as team self-correction appeared beneficial in the improvement of team performance. Teams that had the opportunity to engage in performance monitoring, however, performed better than teams that had the opportunity to engage in team self-correction.

Cognitive task analysis and innovation of training: the case of structured troubleshooting.

Troubleshooting is often a time-consuming and difficult activity. The question of how the training of novice technicians can be improved was the starting point of the research described in this article. A cognitive task analysis was carried out consisting of two preliminary observational studies on troubleshooting in naturalistic settings, combined with an interpretation of the data obtained in the context of the existing literature. On the basis of this cognitive task analysis, a new method for the training of troubleshooting was developed (structured troubleshooting), which combines a domain-independent strategy for troubleshooting with a context-dependent, multiple-level, functional decomposition of systems. This method has been systematically evaluated for its use in training. The results show that technicians trained in structured troubleshooting solve twice as many malfunctions, in less time, than those trained in the traditional way. Moreover, structured troubleshooting can be taught in less time than can traditional troubleshooting. Finally, technicians learn to troubleshoot in an explicit and uniform way. These advantages of structured troubleshooting ultimately lead to a reduction in training and troubleshooting costs.